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When
Tom left home for college, his mother felt more than the usual parental
anxiety to see him go. Tom is highly allergic to peanuts, a condition his
mother has kept under control at home by carefully scrutinizing labels and
preparing most foods from scratch. Although Tom takes his condition seriously,
he suffered two life-threatening events in high school, both away from home.
One involved ordering a sundae at a soft-serve ice cream store. He asked
for sprinkles on his ice cream and even explained to the server his allergy
to nuts. Apparently a small piece of crushed peanut had contaminated the
sprinkles, however, and within minutes Tom’s throat and lips had swollen,
and he was having difficulty breathing. Fortunately, he carried a syringe
of epinephrine which he injected, and friends got him to an emergency room
quickly where he was treated and stabilized. His mother knows that living
away from home he’ll face many such precarious situations.
Tom, along with a little over one percent of adult Americans, has a true
food allergy. Food allergies are more common in children, affecting about
three percent of children under age three. Many children outgrow their allergies,
however. Surveys reveal that 25 percent of Americans think they are allergic
to certain foods, but most have only a food intolerance.
A food allergy is a hypersensitivity to a specific food that triggers a
reaction by the immune system. The body releases histamines to attack the
invader, which is usually a protein in food. The reaction may be relatively
mild with symptoms such as hives, stomach cramps, diarrhea or wheezing.
More acute reactions include swelling of the mouth and airways, difficulty
breathing, a drop in blood pressure and loss of consciousness. The victim
can go into anaphylactic shock, and such serious reactions can be fatal,
especially if not treated.
Eight foods are responsible for 90 percent of allergic reactions: peanuts,
tree nuts (including walnuts, pecans, almonds, cashews, pistachios), fish,
shellfish (crab, crayfish, shrimp, lobster), eggs, milk, soy and wheat.
Milk, eggs, wheat and soy are often the cause of allergies in children.
Infants who are allergic to cow’s milk or soy can be given formulas
that are made up of sugars and amino acids. Many children will outgrow these
allergies as their immune systems develop and parents can work with their
physicians to determine when it might be safe to test a child to see if
it’s possible to reintroduce a food that had to be avoided in the
early years. Allergies to peanuts, tree nuts, fish and shellfish are rarely
outgrown.
Living with Allergies
There is no cure for allergies. The first line of defense is to avoid
the offending food. This can be difficult if it’s a common food
such as milk, eggs, nuts or peanuts–all common ingredients in numerous
pre-packaged foods and restaurant dishes. Eliminating common foods and
classes of foods can also pose nutritional challenges.
The first step is to have an allergy correctly diagnosed. Keeping a food
diary for a couple of weeks can help identify allergic triggers. There
are also a number of tests that can be performed by your physician or
an allergist to test reactions to specific foods. When a serious reaction
has occurred, care must be taken to avoid exposing the patient to a potentially
harmful allergen.
Patient and family education are essential elements of the treatment plan
once an allergy has been identified. Those who suffer severe allergic
reactions need to be extremely vigilant in avoiding contact with taboo
foods. It’s important to read food labels on packaged foods carefully
and to know all the terms a specific food may be listed under. Milk may
be listed as “caseinate” on an ingredient label, or eggs as
“albumin.” Consumer groups, the Food and Drug Administration
and food industry representatives are working on clearer labeling using
common terms for the most common allergens.
Customers who ask a waiter or cook in a restaurant about the safety of
ingredients may not get reliable information. Restaurants use a number
of prepared items and may not know all the ingredients. A waiter who guarantees
there are no peanuts used in a dish may be unaware that peanut oil was
used in food preparation, for example.
Individuals with potentially serious allergies should always carry a syringe
of the drug epinephrine and know how to administer it if a reaction begins
to develop. In addition to administering epinephrine it’s important
to then seek medical care at an emergency facility for further treatment
and observation. Epinephrine is available in convenient forms such as
Epi-Pen or Ana-Kit and requires only a prescription from your doctor who
can demonstrate how to use the syringe.
Allergic reactions to food send 30,000 people to emergency rooms in the
United States every year and are responsible for more than 150 deaths
annually. Many of these deaths could be avoided with better labeling of
food products and an increased awareness of the potential danger of an
anaphylactic reaction. One study found that despite the known dangers
of a serious peanut allergy, only half of the adults in the United States
who reported serious allergic symptoms after eating peanuts made an appointment
with a doctor as a result. Only seven percent of those with a serious
peanut allergy reported carrying an emergency epinephrine kit.
Serious allergic reactions, often involving the lungs, are more common
in persons who also suffer from asthma so they should be particularly
vigilant about avoiding allergens and carrying an emergency kit.
Parents of children with allergies need to work with daycare centers and
schools to ensure that school personnel are aware of their child’s
allergy and that there are always staff on hand who know how to cope in
an emergency.
Some schools set up a special area of the lunch room for children with
allergies to ensure they don’t inadvertently come into contact with
food that might pose a threat. For some extremely sensitive children just
sitting next to someone eating a peanut butter sandwich and inhaling the
smell might be enough to trigger a reaction.
Being allergic means having to be alert and assertive. Read labels on
all purchased foods, ask for information in restaurants or request that
a special dish be prepared for you. If you’re a guest in someone’s
home, tell them about your allergy ahead of time or ask about ingredients
in anything you eat. The safest strategy for those with severe allergies
is to prepare foods from scratch at home and avoid packaged foods and
restaurant meals as much as possible.
For more information about food allergies and labeling contact The Food
Allergy and Anaphylaxis Network (FAAN). Phone: (800) 929 4040. Their web
address is www.foodallergy.org. FAAN is a non-profit group working to
increase public awareness of allergies.
REFERENCES:
“Food Allergies: How Worried Should You Be?”
Tufts University Health and Nutrition Letter, April 1999.
“It Must Have Been Something I Ate,” Consultant, June 1999.
Anne Munoz-Furlong, “Living with Food Allergies,” FDA Consumer,
July 2001.
Howard Peiper, “What You Need to Know About Food Allergies,”
Better Nutrition, March 2000.
Hugh Sampson, “Food Allergy,” JAMA, December 10, 1997.
Carol Saunders, “Fatality Risks from Food Allergies,” Patient
Care, April 15, 2001.
David Schardt, “Food Allergies,” Nutrition Action Healthletter,
April 2001.
“Schools Accommodating Children with Allergies,” Health Letter
on the CDC, March 27, 2000.
Miriam Tucker, “Patients with Food Allergies Confront Gaps in Food
Labels,” Family Practice News, April 15, 2001.
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